German Heilpraktiker practice

Lay practitioners before the twentieth century

Historians describe a large non-physician healing market in German-speaking lands well before the Heilpraktiker existed. A history of the homeopathic lay practitioner Arthur Lutze (1813 to 1870) in Prussia notes that he was not licensed, built his popularity by focusing on ordinary people, and drew legitimacy from the work of certified doctors, and that the paper helps explain the extraordinary popularity of non-medical practitioners in that period.

A study of Imperial Germany describes physicians who tried to claim hypnosis for medicine by drawing boundaries against stage hypnotists, magnetic healers and occultists. It finds that these boundaries helped exclude lay practitioners but were blurred by the physicians' own occult interests and public experiments. Both papers show that conflict between physicians and lay healers predates the twentieth century.

The profession in the Third Reich

A historical article by Edzard Ernst states that a powerful trend toward natural ways of healing developed in the nineteenth century, and that by 1930 roughly as many lay practitioners of complementary medicine existed in Germany as doctors. He writes that, to reunify German medicine under the banner Neue Deutsche Heilkunde (New German Healing), Nazi officials created the Heilpraktiker, a profession meant to become extinct within one generation. This is an interpretation by one author, and the source is brief.

Other historical work places the Neue Deutsche Heilkunde in context. A study of the pharmaceutical industry reports that this policy encouraged greater use of plant-based and homeopathic drugs, but that large manufacturers did not take it seriously and that, from the industry's viewpoint, it had passed its peak before 1936. The wider history of how the Heilpraktiker came into being is described in these sources only in outline.

Growth and persistence afterward

Health services researchers describe a profession that did not die out. A Heidelberg survey reports that the number of Heilpraktiker grew from about 9,000 in 1993 to nearly 20,000 at the time of writing. A later cross-sectional study reports about 40,000 practicing in 2014, compared with about 58,000 general practitioners. Both sets of authors say that research on the group is limited, and the counts come from their own introductions.

Names used in German and English

Heilpraktiker is a German word usually rendered in English as non-medical practitioner, non-medical naturopathic practitioner or natural health practitioner. Research papers use all three, and some abbreviate them as NMP, NMNP or HP. One cross-sectional study names the group a non-medical naturopathic practitioner providing complementary and alternative medicine, which signals that the title is broader than naturopathy alone.

Interview research on cooperation with doctors uses the phrase non-medically trained practitioners and notes that, in Germany, not only physicians but also these practitioners can obtain a license to treat patients. The English terms are translations chosen by authors, and the German title is the stable term.

Related and confusable terms

The Heilpraktiker is not a physician and is distinct from a family doctor who adds complementary methods. A national survey of family physicians found that 60 percent of responding physicians reported using complementary medicine in their practice, so the same methods can be offered by doctors and by Heilpraktiker. An anthropological study notes that the title describes a legal figure in Germany, whereas comparable practitioners would be seen as fringe or alternative in the Anglo-American world.

Naturopathy and Heilpraktiker practice overlap but are not the same thing. Naturopathy is a system of practice, and the Heilpraktiker is a job title that can include naturopathic and many other methods. Machipedia describes naturopathy and iridology on their own pages.

Entry route and scope

According to health services papers, a candidate for recognition must pass an examination on basic medical knowledge at a local public health office, and no formal medical training or compulsory curriculum is required. The authors of a Heidelberg study write that Heilpraktiker may carry out a wide range of interventions, with listed exceptions that include gynecology, dentistry, prescribing medication and treating infectious diseases. They add that only those performing invasive procedures such as injections or acupuncture are under intermittent surveillance by public health offices.

A study of schools adds that the examination tests knowledge of conventional medicine only. Schools for the profession therefore teach little about the complementary methods practitioners later offer.

Methods and patients in surveys

A questionnaire study in Schleswig-Holstein invited all 1,096 non-medical naturopathic practitioners in the state, and 262 responded. Of those, 81 percent were women and the average age was 53. The most frequent reasons for consultation were general and unspecified (68.2 percent), psychological (64.1 percent) and musculoskeletal (53.1 percent), and about 68 percent treated pain. The most common group of methods was para-medicinal procedures. The authors call it a first look at a nearly unexplored group, and it covers a single federal state.

In a comparison of patients in 2016, 91 patients of 11 Heilpraktiker were compared with patients of general practitioners. Heilpraktiker patients had a higher education level, were more often female, reported more psychological problems and fewer respiratory problems, and had longer symptom duration. The sample was small, and the authors report lower participation than expected.

Place in the wider system

The Krug study reports that visits to Heilpraktiker are not covered by the public (public) insurance scheme and are paid out of pocket, though most private insurers reimburse them. An ethnography of one practitioner who ran an Ayurvedic spa describes the Heilpraktiker as drawing on several diagnostic and therapeutic approaches, linked to the German tradition of the Kur (spa stay). It is a single-case account and cannot be generalized to all practitioners.

What practitioners report treating

The sources reviewed do not contain a statement by a Heilpraktiker professional body describing what the practice is for. What they do contain is survey data on reasons for consultation. In the Schleswig-Holstein survey, practitioners most often reported general or unspecified complaints, psychological causes and musculoskeletal complaints, and most reported treating pain. These are reports of consultation reasons and not of treatment results.

Scholarly readings of why patients consult

Researchers also describe why patients may seek this route. The anthropological study argues that the range of therapies offered is partly a symptom of what it calls an epistemic impasse at the heart of biomedicine, which sends patients on a quest to different therapeutic settings. This is the author's interpretation, offered as scholarship, and other authors may disagree.

The Krug study found that patients seeing Heilpraktiker reported longer symptom duration, which the authors link to chronic health problems. They read this as showing a need for action on complementary therapy in primary care and on regulation.

What the research covers

The research found for this page describes the profession, its schools, its practitioners and its patients. It does not test whether the treatments Heilpraktiker offer work. A PubMed search for the term Heilpraktiker returned 44 records, and the records opened for this page were surveys, interviews, historical and ethnographic papers, and commentary. No randomized trial or systematic review of Heilpraktiker care as a whole was found. Because the title covers many different methods, evidence for one method would not carry over to the profession.

Training and schools

Hoffmeister and colleagues found 165 schools for non-medical practitioners in a systematic web-based search. They report that 83.0 percent (137 of 165) did not meet the education requirements framed by practitioner associations, and that few schools offered education in complementary methods. They state that patients and physicians should be aware of the lack of training and its risks, and they suggest that disestablishing the profession might be reasonable. That recommendation is the authors' view, and the study is an analysis of course subjects and not of patient outcomes.

Physicians' views and the wider debate

In interviews with 15 physicians and 2 dentists, doctors were partly willing to cooperate with non-medically trained practitioners, usually for minor ailments, but only under strict conditions. They showed low confidence in the training programs and thought it harmful when practitioners tried to interrupt conventional treatment or medication. The sample was small and qualitative.

Among family physicians surveyed in Germany, about 59 percent supported quality control for Heilpraktiker, and the authors of that survey question the role of non-medical practitioners in the health system. Its response rate was modest, at 34 percent for most questions.

The Münster Memorandum, a statement by a group of academics, criticized what it called double standards between physicians and alternative practitioners for minimal competency and quality assurance. A later paper collected and analyzed the critical reactions, which it describes as numerous, divergent and sometimes emotionally heated. The debate is therefore active, and the sources reviewed here do not settle it.

Risks named by researchers

Hoffmeister and colleagues name harm to the body, delay of necessary treatment and interaction with conventional drugs as risks that follow from limited training. These are stated as risks in an abstract and are not frequency estimates. The sources reviewed did not provide systematic counts of adverse events attributable to Heilpraktiker care, so the size of these risks is not established here.

Physicians interviewed in a separate study named interference with the physician-patient relationship and interruption of conventional treatment as potential harms. The Krug authors call for attention to quality and patient safety given the growing numbers of practitioners and the absence of a regulatory body.

Care boundaries and scope of this page

Sources describe limits on the profession, including exclusions for dentistry, gynecology, prescribing medication and treating infectious diseases, and intermittent surveillance for invasive procedures. The physicians interviewed in one study regarded interruption of conventional treatment as harmful, and the sources reviewed do not support more specific advice. As a general care boundary, necessary medical care should not be delayed or replaced. This page is information only and is not a recommendation for or against any practitioner.

This page covers Germany only. The Heilpraktiker title and its conditions are specific to that country, and the sources reviewed do not describe other countries' arrangements. Legal texts and enforcement material were outside the scope of this page.